Homestead_Payne ...
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF oral GOVERNMENT FINANCE IC6-1.I-22-8.1
nlljA\ Fanljaaril0 WM 4S. AD P10 • 4R' Y O\YN st. -
, Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
deduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
auses higher tax bills for all; therefore, HEA 1344-2099 requires taxpayers who receive the homestead
st ndard deduction to verify that they are eligible to receive the benefit and to provide additional identifying .
information necessary to allow county government to'better monitor homestead filings.•This'ihformation
will be kept confidential and can only be accessed by authorized county officials. The Department of Local
Government Finance will use this information to create tools that will help county officials eliminate
• homestead fraud.
1r J1 P' o ' • IAI, e - o
Taxpayer Name Property Address State Parcel Number Leta)Descriauon:
Jerry I./Bonnie J Payne 9701 S. 250 W. 26-18-34-200-000.899-024 004-00899-00 FT NE 34 3 I 1 4.10 AC
Fort Branch, IN 47648 )( 0-27 thj
Complete and return to: -
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
P: 'TA3TAXPAl1ERINFORMATION
Owner 1 First Middle Cast
I
2 irb L. �u//r P� e-^� �Jl/v2
Ma3ng Address(number and street y state and ZIP cede) !�/Same as property address 9701 S 250 W
976 1 S ‘,2_,5 ofd ' U fC p(AYV Pi AIJ jrs .Fort Branch,IN 47648
- Middle last '
Mailing AM. .m�s..n.•.• ..m..;2y,state and ZIP code)
9701 S 250 W �C� Same as property address
Branch,Fort Bch,IN 47648 V •
__ _ _- PAR 3: ■ERR 1F_ICA' 'ION
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that he or she is eligible to receive the
homestead standard deduction on this property. Each undersigned also understands that,by claiming additional homestead deductions unlawfully,he or
she may be liable for back taxes and substantial financial penalties.
Owner l Si nature Date
PARWaADDITIONAL INFORMATION
A-9« ta e 7 nt ice-- , cl 4 V 274. s,� f . .
i,..nq
� � CLAIM FOR HOMESTEAD PROPERTY TAX
a��;; CREDIT/STANDARD DEDUCTION
.:�j State Form Sd73 (R2 / 5-92)
,.�.
INSTRUCTIONS: See reverse side for liling instrucfions.
- _ � �� � � � - • � CERTIFICATP
FORM
HC10
YEAR
I(We) - ' certify.thaYori the 1sf day of March, 79_
�e) occu as our pri i I p ace of r dence the following described real property for which aF/j/a� estead Pro erty�x Cred///itJ��is h//er��eby claimed:
u I(We) owned ❑ Are buying under contract �}'�; �,��,_.�JJ�� ��
id-�„ ( ;';.._ _�
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and �at owns tF�'e p7opeity or 5 66 "n n er a contraci.
li huying on contract. Fee Simple owner's name
Coun � • " Township
umber Legal description
o�
li any portlon ot the resitlenlial struciure or the larxl not ezceetl'.
of ihe property utilizetl to protluce income.
PROPERTY
�t OJC 3�"- 3 l/
one (1) acre Nat immetliately surmunds lhat siruciure is usetl to
Record number
e income,
Page
the use and ponion
ASSESSOR USE ONLY ,� TRUE TAX ASSESSED HOMESTEAD NON•RESIDENTIAL .�
VALUE VA�UE VALUE VALUE �
Land not exceeding 1(one) acre immediately
surrounding resideniial improvemenis. (�) � -
Otherland (p) .
Total land Qine 1 pNs line Z� � (3�
Dwelling (4) - , -
Residential improvements
. Garage (5) - .
Other improvements (6)
Total improvemenis (line 4 fhrough line � (7)
Total value (line 3 p�s line � (g)
I hereby certify Ihe above is Irue, correct, and Sgnature of Assessor Oate signed
complete.
IVeritying action - SignaWre of Audiror Dare sfgned
•' .
79 _ Pay 79 _
Lesser of tl2 Homestead
Valua�ion or 32,000
STANDARD
S
I Date sig — � —^
lJ